Anaesthetizing apparatus



Nov. 12, 1935. w. R. HENION Q 2,020,643

AN/ESTHETIZING APPARATUS Filed Aug. 28 1955 3 Sheets-Sheet 1 INVENTOR WALT R. HENION ATTORNEYS B VFM I Nov. 12, 1935. A w R HENlON 2,020,643

AN/ESTHETI Z ING APPARATUS Filed Aug. 28, 1953 3 Sheets-Sheet 2 INVENTOR WALTER HENION I m W l5 ATT RNEYS I Now 12, 1935. w R, HENloN 2,020,643

ANKESTHETI Z ING APPARATUS Filed Aug. 28, 1935 5 Sheets5heet 3 42 INVENTOR 14 WA LTEH R. HENION ATTORNEYS Patented Nov. 12, 1935 UNITED STATES ANZESTHETIZING APPARATUS Walter R. Henion,

Minneapolis, Minn.

Application August 28, 1933, Serial No. 687,109

24 Claims.

This invention relates to improvements in apparatus for administering inhalation fluids and has, as an important object, the control of delivcry of such fluids as a result of respiratory effort.

The invention finds valuable application in controlling analgesia particularly dental analgesia, a condition in which the patient cannot feel pain but retains voluntary motor ability. Exact control of analgesia is diflicult of accomplishment since the control must, so to speak, be geared to the patient. The present invention provides for a control exactly suited to the needs of the individual. A feature of the invention relates to an arrangement whereby a valve controlling the delivery of inhalation fluid is operable by the patient as a result of reflex or voluntary gripping when in pain.

The invention also relates to an apparatus wherein the respiratory effort of the patient is utilized to control the flow of inhalation gas, either anasthetizing or nonanasthetizing substances or analgesic substances, to the organs of respiration. A feature includes an arrangement whereby the valves can be manually set to admit .analgesic fluid and stop the flow of air to the patient and where in these valves are automatically reset after a predetermined number of inhalations or exhalations by the patient to stop flow of analgesic fluid and admit air.

Another feature relates to the means whereby the patient controls these valves at all times independently of any control by respiratory effort, so that the valves can be moved to one control position, whatever the state or position of the valve control means, which is operated as the result of respiratory eifort.

In the present embodiment, the keeping of the patient in a state of analgesia is accomplished by permitting the patient to take a predetermined number of breaths of anaesthetizing or analgesic gas after which the flow of anaesthetizing fluid is stopped and air is allowed to flow to the organs of respiration. The method of patient control is of great importance because both the gas flow and the air port valves are manually controlled by the patient by means of the gripping action of one hand.

Features of the invention include all details of construction, as well as combinations and subcombinations of the parts, along with the broader ideas of means inherent in the disclosure.

Objects, features and advantages of the inventionwill be set forth in the description of the drawings forming a part of this application, and in said drawings Figure 1 is a side elevation illustrating my apparatus for administering inhalation fluids;

Figure 2 is a. vertical longitudinal section of one form of apparatus taken approximately on line 2-2 of Figure 3 with the parts set for delivering anaesthetic or analgesic fluid;

Figure 3 is a vertical transverse section approximately on lines 3--3 of Figures 1 and 2;

Figure 4 is a vertical longitudinal section approximately on line 3-4 of Figure 3; and

Figure 5 is a vertical longitudinal section of a modified form of apparatus taken approximately on line 2-2 of Figure 3 with the parts in their initial position, as before operation by the patient,

The present device may be applied to any suitable' type of machine but has been illustrated as applied to that type of machine shown in my copending application for Anasthetizing apparatus, Serial Number 644,219 filed Nov. 25, 1932.

First referring to Figures 1 and 2: Numeral l indicates the top portion of a floor standard acting as a support for the apparatus. Mounted on the standard is a frame structure including various tubular members forming passages for the inhalation fluids. The lower part of the structure includes yokes 2 which may be of any preferred form for supporting the gas containers and connecting them to deliver into the system. Pairs of yokes are generally provided, two for containers of nitrous oxide and two for containers of oxygen. The gas containers have not been shown. The usual pressure-regulating device is generally indicated at 5. There are generally two of these devices. A suitable pressure gauge is indicated at 6.

Whatever the construction of this part of the apparatus, the gases (whether mixed or not mixed) finally are delivered to a passage [0, herein referred to as the delivery passage. This passage, see Figure 2, is formed in the wall of a casing generally indicated at l l and in a tubular member l2, by which the casing is attached to the supply machine. This casing is provided with an air intake passage l3, and a bag passage l4, formed in enlargements and extensions of its lower wall l5. The bag I 6 suitably attached to an extension communicates with passage M.

The breathing line generally indicated at I! is provided with any preferred form of mask indicated at [8, preferably without any valve, since all inhaling and exhaling openings or valves are at the chamber 1 I. This tube is suitably attached to a tubular member 20, see Figure 2. This tube passes through the vertical wall of the casing H, and has a down-turned terminal portion 2! capped by a removable casing 22 having an orifice 23 in its lower wall, normally closed by a gravity acting plate valve 24. The valve 24 is raised during inhalation and falls to closed position during exhalation.

The passages I 0, l3 and M are controlled by a valve means, in this instance including a bar 29 translatably guided by rollers 3|. The end 30 of the bar functions as a valve, cooperating with valve seat 32 to close the delivery passage [6.

Attached to the bar by cross pin 34 is a block 35 which is part of the valve structure for closingeither the air passage It or the bag passage Id. Referring to Figure 3, this block has extending from its broadened bottom, guide pins 3% which loosely traverse openings 3? of valve element 38. A spring 39 housed in a socket of the block 35 sealingly presses the valve element 38 against the upper surface 46 of the lower wall of casing ll. V

The sequence of operation of the valves is the same as in my copending application previously mentioned. Referring to Figure 5, when the valve 35? of the bar 29 is closing the passage it], the valve 38 closes the bag passage it. When the valve to is open, see Figure 2, the valve 38 is closing the air passage and the bag passage is open. 7

site direction the air passage is first opened and then the delivery and bag passages are closed.

A spring &2 moves the valves 38 and 33 normally to the position shown in Figure 5. To move the valves against the action of this spring to open valve 363 and obtain a supply of fluid from passage it there is provided a patient-controlled means. This means includes a plunger d3 slidable in the Wall of the casing l i and this plunger has a head it inside the casing. Rotation of the plunger s3 is prevented by means of pin 45 passing loosely through an opening in the head 4 The head cooperates with the vertical wall to limit outward movement of the plunger. Spring 46 is attached to the head M and acts to advance the head in a direction to obtainlatching. In Figure 5, it acts to advance valve 39 to closed position. 7

r In order to provide a device by which the patient can control the valve means by hand, either to close or open the same, coupling means is used to draw the valve means to the position shown in Figure 2 against the action of the springs 42 and M. This coupling means has herein the form of a latch ll pivoted as at 58 to the head M. This latch has a notch 5-9 cooperative with pin 3%, and a spring 55 moves the latch to latching position. llapward movement of the latch is limited by pin Referring to Figure l: The patient-operable valve control means includes, in addition, a wire es suitably attached as at E5! to the plunger, said wire passing through a tubular member 62 rotatable and translatable upon a tubular extension 53 in which the plunger 43 slides. This tubular member may be translated outwardly by the doctor to bring its inner face 54 into abutting engagement with the outer surface 65 of the tubular member (53, to hold the valve mechanism in the position shown in Figure 2, independently of operation of the valve mechanism through means of the wire es.

For administering anaesthesia, as distinguished from analgesia, it is not necessary that the breath-actuated mechanism operate, nor under these conditions is it possible for the patient to control any part or" the mechanism. This being the case, the patient control grip is allowed to hang from its support on'the casing, and the swivel sleeve 6! is pulled out to its locking position, in the manner previously described in which position the air port is closed and the main valve 3!! is open for delivery of anw'sthetic. Thus, the manually operable patient control device is made inoperative, so as not to interfere with the ad- 5 ministration of anasthetic fluid. At the same time, the breath-operated means is rendered inoperative in a manner below set forth.

To the outer end of the tubular member 62 is attached one end of a flexible tube 66 in this 10 instance formed by a wire coil. To the outer end of this coil is attached a stiff tube 61. To the opposite end of the tube 61 is attached another coiled wire tube E9 and to this is attached, by means of tubular element 10, a gripping element l! which has substantially the same form as the grip of an automatic pistol. Pivoted to this grip element is a trigger it which is related to the element l! as the corresponding member of the grip of an automatic pistol. To the other end of this grip, the wire 68 is attached, and when the grip is moved inwardly sufficiently from its position shown in Figure l, the valve means is moved to the position shown in Figure 2. This is an important feature of the invention, since the flexible connection 68 allows the grip to be swung to any angular position, and the valve means can be operated by a gripping action of the whole hand, without necessity for motion of any other part of the arm. Thus the patients arm can rest on a chair arm or bed, and the valves can be controlled simply by gripping with the entire hand.

A broad feature of this invention is means operative as the result of respiratory efiort to control the valve means in a predetermined manner. There is no intention to be limited to the particular kind of control means, although a specific control means is also claimed herein. In this instance, respiratory efiort effects the tripping or the latch 41, after a predetermined number of respiratory motions, to stop flow of analgesic or anaesthetic substance to the patient. In this way, the pressure set up by the'patients breathing controls closure of the valve. On the other hand, the patient can at any time release the grip on the element i2, and obtain closure of the valve 39, and opening of the air valve 38. These valves are thus controlled independently of any breathing eiiort by the patient. A device is thus provided which is under full patient control for opening or closing the delivery valve by hand, and for closing as a result of a predetermined amount of respiratory effort.

The latch M has an extension 15 which is adapted at the end of a certain number of respiratory movements to be engaged and depressed by pin it to release the latch. This pin is carried by a ratchet wheel H (see Figures 2 and 3) suitably rotatably mounted, see Figure 3, on a stub shaft l8 secured to wall E9 of the casing by screw 88. Rota-table about a tubular extension 83 of the wheel and attached for movement therewith is a drum 8| having a flange frictionally engaged bya wire 82 acting as a brake to 55 prevent over-run, and to hold the wheel in any of the successive positions towhich it is rotated. The drum is secured to the wheel extension by means of a set screw 84, so that relative angular adjustment can be obtained. 7

The ratchet wheel is rotated by pawl 85 pivoted to arm 86, in turn pivoted on the tubular bearing extension 33 of the ratchet wheel. The outer end of this lever is attached as at 81 to'a vertical stem 96 passing upwardly loosely through tubular extensions 9| which communicate with the tube 20. The stem 90 is attached as at 92 to a diaphragm 93, having its periphery suitably sealingly clamped between members 94-95 by means of screws 96. The upper member 95 has an air vent 9?. The stem is slidably guided in the member 95, and a screw 98 is provided for securing the stem in fully raised position when its operation is no longer desired. The teeth only extend part way around the ratchet, to keep the breath-actuated mechanism from moving the wheel after tripping has taken place and before relatching and re-setting by the patient. Moreover, such continued movement would so tighten the flexible element I III as to render the bellowsoperative stem inoperative.

The stem has a disk 99 loosely operating in the lower extension 9| to substantially prevent exhalation flow in the direction of the full line arrows, so that such exhaled fluid will move the diaphragm upwardly, also in direction of the full line arrows, thus raising lever 86 and causing pawl 85 to rotate ratchet wheel H the distance of one tooth in the direction of the arrow, or clockwise. There may be any number of ratchet teeth. Adjustment of the pin to cause tripping of the latch by a greater or lesser number of respiratory efforts can be made by loosening set screw 64 and rotatably adjusting the wheel relative to the drum. By this means, adjustment to the needs of the particular patient can be made, when required; but it will be noted that the patient can stop the flow at any time, independently of the breath control. The ratcheting mechanism is only operable when the valves are in the position shown in Figure 2.

During exhalation, valve 24 prevents exit of out-breathed fluid, the valves 24 and 99 acting together for this purpose. During exhalation, valve 99 rises to the position shown in dotted lines. As the patient inhales, valve 24 moves in direction of the dotted line arrow. Pressure is reduced in the tube 20, the diaphragm falls to the position shown in Figure 2, and the pawl is lowered to engage another tooth of the ratchet wheel. The disk 69 also acts as a guide for stem 90. It is conically and downwardly convergently formed on its lower side to assure registration with and free entry into the tubular extension Si on its way down from the dotted line position shown.

Means is also provided for setting the ratcheting mechanism in a predetermined initial position, so that pin I6 will always start its motion from a given position and therefore always move a given distance, to tripping position. In this instance, it is set as a result of movement of the latch 47 to latching position. In the modified form of Figure 5 this setting takes place on movement of valve 30 to out 01f the supply of analgesic or other fluid.

Referring to Figure 4, which shows the position of the parts when the valve 30 is closed: Secured to the drum 8| by one end. as at I is a flexible element I M secured at its opposite end as at I62 to a lever I03 pivoted as at I04 to the rear wall of the casing. The lower arm of the lever is pivoted to link I05 in turn pivoted as at I06 to the head M, see also Figures 2 and 5. A guide roller I0! is provided. The flexible element IOI operates to rotate the drum and ratchet Wheel in counter-clockwise direction to bring the pin to the initial position shown in Figures 2 and 5.

As the latch moves to latching position, link I05 acts on the lever moving its upper end in clockwise direction as shown by the arrow, to slacken the element IOI, so that the drum can move in clockwise direction, as a result of ratcheting movements. During drum motion in clock- 5 wise direction, the element IOI is wound on the drum to take up sufficient slack to assure that on movement of the lever I03 to the position shown 7 in Figures 4 and 5, the pin 16 will again be brought to its initial position. Thus the patient 10 re-sets the ratchet. In Figure 5, the lever I03 acts as valve 30 closes.

As the lever I 03 moves to the position shown in Figure 2, its periphery engages a pin H9 of pawl 85 to move the pawl to operative position. To assure that this operation will take place, even when the lever 86 is in its uppermost position, the lever I03 is provided with an upward extension II I. At the same time, a pin H2 carried by the lever I03 engages a spring arm H3 to move it to the position shown in Figure 2, to permit movement of the pawl to operative position. This spring arm H3 acts to move the pawl to; inoperative position and thus acts when released by movement of the lever I03 to the position shown in Figure 4, that is on movement of the latch to latching position. This pawl release, of course, takes place before action by the flexible element IBI on the drum begins, to bring the pin 16 to initial position, Thus mechanism is provided for setting the ratcheting mechanism in a predetermined initial position as the result of movement of the latch to latching position. In Figure 5, this setting takes place on movement of the valve 30 to closed position.

It is noted that at any time before the pin I6 trips the latch, the patient can, by releasing the grip on the element I2, allow the valve 30 to automatically move to closed position.

Referring to Figure 3, the pin 34 is used here- 40 in to operate a mechanism for signaling the operator or patient that the valve 30 is closed, and that air is available through passage I 3. The pin engages the slot of lever H5, the lever being suitably pivoted as at H! on removable cover plate H6 of the casing II. The pivot II! has attached thereto, at the outer side of the plate I I6, a. resilient arm I I8 having a ball I I9 adapted to ring bell I20.

A feature is the placement of an exhaling valve on the casing, to take care of all exhalation, in lieu of its placement on the mask. To this end, plate H6, see Figure 3, has an opening in which a tubular member I2I is fltted. Threaded to this member I2I is a sleeve I22 having openings I23 and seated against the outer end of the tube I2I is a valve I 24. The outer side of this valve is engaged by a light tension spring I25, the tension of which can be adjusted by cap I26 having threaded engagement with the sleeve I22. This valve prevents over-distension of the bag and building up of counter-pressures against the diaphragm of the breath-actuated mechanism and is a valuable feature. An air valve I24 is also installed on the casing. It has a rotatable cap I2 I by which it can be adjusted. The valve is used for control of analgesia, and also tends to prevent over-expansion of the bag and relieves counter-pressures. It permits dilution of analgesic fluid while the air intake passage I3 is closed and without re-setting the regulator. Such valves have generally been used on masks.

In Figure 5 a modification has been shown in which the element 29 instead of being movable with the element 35 is movable independently 7 of this element and is rigidly attached tothe plunger 3. The element 35 in this instance slides upon the bar 29 and the pin 3 1 does not pass through the bar 29 as in the first case. The other structures of this form are otherwise substantially identical with those previously described.

In Figure 5, the main gasvalve 3B is not controlled by the patients breathing, but is only controlled by gripping action of the hand of the pa tient, and not as a result of respiratory effort. In this modification, the breath-actuated mechanism is used solely for opening the airport, and closing the bag passage, but the patient may still move this valve to close the air port by gripping action of the hand, and must so move it to condition it for breath-control. It will be seen that the patient can open and close the delivery opening It independently of the position of the valve 38. With this construction, the gas flowing after the air port has been open, is diluted with atmospheric air, and the patient breathing this diluted substance is made to remain in a deeper stage of analgesia than would be if the gas were completely shut oil. In this case the alarm gives warning that the air port only has been automatically opened by the breath-actuated mechamsm.

As in my previously mentioned case, means is provided by which gas from either supply carboy can be directly introduced into the breathing line without passing through the main delivery passage is. In this way N20 or oxygen, or both,

may be bypassed. For this purpose, pipe connections are made with the chamber of each regulator, the connection being herein shown only for one of the regulators i353. The pipe It! extends upwardly and traverses the wall of the chamber ii and the pipe 28, and delivers directly into the tube as at that portion of the tube which lies, in the drawing, at the left of the diaphragm-operated stem 9%. The pipe has a valve E32, and any amount of gas can be bypassed independently of any control by the patient and at the will of the anesthetist or operator. Suitable means for gauging the amount of bypassed fluid is used and includes graduated dial i333 and finger 5341 atached to the valve moving there-over. The bypassage is generally adjusted to supply greater or lesser quantities of gas than is normally delivered through the main passage iii. It is noted that the bag is also bypassed so that gas is shot directly and quickly to the patient without mixture in the bag. With bypass, the patient cannot entirely out off the inhalation fluid. Although he can close the main supply valve 39, the bypass continues to deliver into the inhaling tube. When he does close the main valve, he gets a mixture of air as before, the only result being that he cannot get as much air as he wishes.

This scheme somewhat parallels the effect of using the device with means for administering gas to a patient through more than one passage, when the gas is flowing through more than one passage simultaneously. With the second passage for gas, means have been provided for gas to flow after themain passage has been closed, and this gas flowing from the second passage mixes with the air from the air port to assist in the maintenance of analgesia. This mixing of gas with air only takes place, of course, while the air port is open.

Operation In the operation of the device, when analgesia tance equal to the length of a ratchet tooth. 10

After a certain number of exhalations have been made, the latch 41 is tripped and valve 30 is closed, valve 33 uncovers the airport and closes the bag passage.

When the patient releases the grip, lever I03 is moved to the position shown in Figure a, releasing the spring H3 to let it engage the pin i H] and pull the pawl rom operative position. Flexible element HH then acts to move the ratchet wheel in counter-clockwise direction to the position shown in Figures 2 and 5.

In the operation of Figure 5, the patient 0perates the grip to move plunger 43 to open valve 30, and by means of the latch to move valve 38 to close the air passage. Thereafter as the patient breathes, the pin 16 is moved to finally trip the latch and release the valve 38 only, which then moves to the position shown in Figure 5 to open the air port. At this time if the patient has continued gripping action, the valve 39 is in open position. While this remains open, and While the valve 38 remains in the position shown in the figure, a mixture of air and anaethetizing or analgesic substance is available for the patient.

The success of any device for obtaining and maintaining a state of analgesia depends upon a fine adjustment to the needs of the particular patient. Because of the different requirements of the diirerent patients, it is a diflicult problem to provide a device which, so to speak, is geared up 40 to the patient, that is a device which can be controlled by the patient or by the patient and the doctor in just the proper way to unfailingly maintain analgesia. This invention provides such a fine and sensitive control because part of the control is by the respiratory effort of the patient, and part is by the hand of the patient. In this way, a very exact and unvarying control can be had.

Although the device shown herein is designed to power-operate during exhalation, it is obvious that the device can be made to operate on inhalations without departing from the spirit of the invention.

It is contemplated herein that the air alone, or any combination of fluid substances, be con trolled by respiratory action in the manner set forth, and there is no intention to limit the invention onlyto alternate control of air and inhalation gases, one of the broad features herein being the idea'of control of a valve both manually and/or by means of respiratory action during administration or" any inhalation fluid or fluids. 7 I

I claim as my invention:

1. In combination with a patient-controlled apparatus for administering inhalation fluids, a breathing line for the patient operatively connected with said apparatus, valve means for controlling fluid flow to the line, means manuallly operable by the patient to position the valve means to obtain fluid flow to the line, and means operative as the result of a predetermined number of respiratory movements to operate said valve means independently of said manual means to stop fluid new. 7

2. In combination with an apparatus for administering inhalation fluids, a breathing line for the patient operatively connected with said apparatus, valve means for controlling the flow of two fluids to the line in a manner to stop flow of one fluid while the other is flowing, means manually operable to position the valve means to obtain flow of one of the fluids to the line, and means operative as a result of respiration to operate said valve means to stop the flow of that fluid.

3. In combination with a machine for administering inhalation fluids, a breathing line for the patient operatively connected with the machine, valve means for controlling fluid flow to the line, means manually operable by the patient as a result of the gripping action of the entire hand without other movement of the arm to position the valve means to obtain fluid flow to the line, and means operative as a result of a predetermined number of respiratory movements to operate said valve means independently of said manually operable means to stop fluid flow,

4. In combination with a device for administering inhalation fluids, a breathing line for the patient operatively connected with said device, valve means for controlling fluid flow to the line, means for moving the valve means to flowpermitting position, latching means for releasably securing the valve means in that position, and means operative as the result of respiratory efiorts for tripping the latching means to obtain closure of the valve means.

5. In combination with a device for administering inhalation fluids, valve means for controlling fluid flow to the line, means-for automatically moving the valve means to one control posltion, latching means for moving the valve means to flow-permitting position against the action of the automatic means, and means operative as theresult of respiratory efforts for tripping the latching means to obtain closure of the valve means.

6. In combination with a device for administering inhalation fluids, a breathing line for the patient operatively connected with the device, valve means for controlling fluid flow to the line, means for moving the valve means to flow-permitting position, latching means for releasably securing the valve means in that position, means for tripping the latch to close the valve means, including a ratcheting mechanism, and means for setting the ratcheting mechanism in a pre determined initial position, as a result of movement of the valve to flow-permitting position following a tripping operation.

'7. In combination with a device for administering inhalation fluids, a breathing line for the patient operatively connected with said device, valve means for controlling fluid flow to the line, means operable as a result of the gripping action of the entire hand of the patient without other movement of the arm for moving said valve means to flow-permitting position, latching means for releasably securing the valve means in' that position, means operative as the result of respiratory effort for tripping the latch to close the valve means, including a ratcheting mechanism, and means for setting the ratcheting mechanism in a predetermined initial position, as a result of movement of the valve to flowpermitting position following a tripping opera tion.

8. In combination with a device for administering inhalation fluids, a breathing line for the patient operatively connected with said device,

valve means for controlling fluid flow to the line, patient-operable means for moving said valve means to flow-permitting position, means for releasably holding the last mentioned means in that position, means operative as the result 5 of respiratory effort for tripping the latch to close the valve means, including a ratcheting mechanism, and means for setting the ratcheting mechanism in a predetermined initial position with reference to its pawl as a result of movement of the valve to flow-permitting position following a tripping operation.

9. In combination with a device for administering inhalation fluids, a breathing line for the patient operatively connected with said device, valve means for controlling fluid flow to the line,

patient-controlled means for moving said valve means to flow-permitting position, including a latch which is releasable to permit the valve means to stop the fluid flow, while the patientcontrolled means is in valve-open position, and means operative as a result of respiratory effort for tripping the latch to obtain closure of said valve means.

10. In combination with a device for administering inhalation fluids, a breathing line for the patient operatively connected with said device, valve means for controlling the flow of anaesthetic fluid, or air to the line, patient-operable means movable independently of said valve means, said valve means being adapted to move automatically to one position to permit flow of anasthetic fluid to the line, and prevent air flow thereto, and to be moved in the opposite position to prevent flow of anaesthetic fluid and permit air flow thereto, said patient-operable means having a latch which normally releasably couples with the valve means for moving it to anaesthetic fluid-admitting position, means operable as a result of respiratory effort by the patient for tripping the latch to permit automatic movement of the valve means, including a ratcheting mechanism, and means for setting the ratcheting mechanism in a predetermined initial position as the result of automatic movement of the valve, following a tripping operation.

11. In combination with a device for administering inhalation fluids, a breathing line for the patient operatively connected with said device, valve means for controlling fluid flow to the line, patient-operable means movable independently of said valve means for moving the same to valve-open position, said patient-operable means having a latch which normally releasably couples with the valve means for moving it to open position, means operable as a result of respiratory effort by the patient for tripping the latch to obtain closure movement of the valve means while the patient-operable means is in valve means-closed position, including a ratcheting mechanism, and means for setting the ratcheting mechanism in a predetermined initial position as the result of a movement of the valve to flow-permitting position, following a tripping operation.

12. In combination with a device for administering inhalation fluids, a breathing line for the patient operatively connected with said device, valve means for controlling fluid flow to the line, means movable independently of the valve means and having a latch cooperable for moving said means to permit fluid flow, means operable from an initial position to trip the latch after a certain degree of motion,'means operable as the result of respiratory movements of the patient to 7 5 operate the last mentioned means to trip the latch, and means operable as a result of motion to re-latch to restore the latch tripping means to its initial position.

13. In combination with a device for administering inhalation fluids, a breathing line for the patient operatively connected with said device, valve means for controlling two sources of fluid flow to the line to stop one flow when the other is started, means movable independently of the valve means and having a latch cooperable with one of the valve means for moving it to permit fluid flow, means operable from an initial position by step-by-step motions to trip the latch at the end of a predetermined number of such motions, means operable as the result of respiratory movements of the patient to operate the last mentioned means to trip the latch, and means operable as a result of motion to relatch to restore the latch tripping means to its initial position.

14. In a device for administering inhalation fluid, a source of supply of fluid, a chamber in combination with said source and having inhalation fluid, bag, and air passages communicating therewith, a breathing passage communicating with the chamber at two orifices, a check valve controlling one of the orifices to prevent exhalation from the conduit into the chamber, a wall of said chamber having an orifice controlled by an outwardly opening adjustable pressure relief valve, valve means for controlling the inhalation fluid, bag, and air passages, to close the inhalation and bag passages and open the air passage or vice versa, and means operable as a result of respiratory effort of the patient through the breathing passage and orifices thereof to control the valve means, to close the inhalation fluid passage.

15. In combination with a device for admin istering inhalation fluid, a breathing line for the patient operatively connected with said device, a valve for controlling fluid flow to the line, manually operable means for opening and closing said valve, means operable as the result of a predetermined member of respiratory efiorts by the patient to control said valve to close the same, and means by which said manually operable means is operable to close the valve independently of and while said respiratory-operated means is operative.

16. In combination with a machine forqadministering inhalation fluid, 'a breathing line for the patient into which the fluid is delivered from the machine, valve means for controlling fluid flow from the machine into the line, and means operative as a result of a predetermined number of respiratory efforts of the patient, through the breathing line to operate said valve means to stop the flow.

17. In combination with a machine for administering inhalation fluids, a breathing line for the patient into which fluid is delivered from the machine, a valve for controlling flow from the machine to the line, means manually operable to position the valve to obtain flow to the line, and means operative as a result of a predetermined amount of respiratory effort by the patient to operate said valve means to stop fluid ,flow independently of said manually operable valve open.

istering inhalation fluids, a breathing line for the patient, operatively connected with the machine, a valve and means by which said valve is adapted to be manually set to obtain flow from the machine intothe line, means for resetting the 5 valve independently of the manually operable means to stop fluid flow, and means by which the last mentioned means is operated as a result of a predetermined number of respiratory movements of the patient. 10?

19. In combination with a machine for administering inhalation fluids, a breathing line for the patient operatively connected with'the machine, a valve for controlling anaesthetic and nonanaesthetic fluids to obtain alternate thereof to the line, means by which said valve can be set to obtain flow of one fluid to the line, and means by which said valve can be automatically reset to stop flow of that fluid and as a result of respiratory effort of the patient. 20

20. In combination with a machine'for administering inhalation fluids, a breathing line for the patient operatively connected with the machine, a valve and means by whichsaid valve is adaptedto be manually set by the patient to 25 obtain flow from the machine into the line, and means operative as a result of a predeterminednumber of respiratory movements of the patient to operate the valve independently of the manually operable means to stop the flow.

21, A source of supply of inhalation fluid, a breathing line connected with the source, a valve acting for controlling, flow of fluid in the line,- and means responsive to pressure fluctuations in the line resultant from respiratory effort of the patient, for proportionately hastening control action of the valve when the respiratory rate is increased, and for proportionately retarding control action when the respiratory rate is decreased.

22. In combination with a'machine for admin- 40 istering inhalation fluid, a breathing line for the patient operatively connected with said apparatus, a valve for controlling entry of fluid from the machine to the line, and means responsive to pressure fluctuations in the line resultant from respiratory effort of the patient, for controlling said valve. 7 r

23. In combination with a machine for administering inhalation fluid, a breathing line for V the patient operatively connected with said apparatus, a valve for controlling entry of fluid from the machine to the line, and means responsive to pressure fluctuations in the line resultant from a predetermined amount of respiratory effort of the patient for controlling said valve.

24. In combination with a machine for administering inhalation fluids, a breathing line for the patient inoperative connection with the machine, an automatically closing valve controlling the flow of fluid'from the machine into the line, means operable by a positive action of a patient for opening the valve and holding it open, said means including a coupling releasable'for permitting valve-closure while said positive action onthe patient-operable device continues, means responsive to pressure fluctuations in the line resultant from respiratory 'eflort of the patient adapted to obtain release of said coupling 'to' permit valve closure while said patient-operable means is being positively operated to hold the WALTER R. HENION.

delivery 15 

